Monday 9 February 2009

Healing Hands

One lady in a care home, with advanced dementia, has a rather feisty disposition. Her daughter's more vehement in her assertions, saying, "She's a vile creature, she's always been evil, really evil!"

As her dementia has progressed, so her frontal lobe function's deteriorated and she's become more disinhibited, her natural demeanour has come to the fore, with any veneer of civility or decorum being long lost, now.

The care home staff describe her as being an active soul. She fills her time to her amusement and satisfaction, "Tormenting other residents with wicked words and abuse," through throwing food she doesn't like from her plate onto the floor, or at carers, grinning as she does so, snatching food from other folks plates if she wants it, saying hurtful things just to get a response, "That's your daughter going, is she? Must be bored with you, what with you saying the same things to her all the time, I expect she's glad to be away."

My nursing colleagues saw her a number of times. I saw her once to establish diagnosis, capacity and exclude a treatable mood disorder.

I use risperidone as a depot medication for a number of folk but I can't think, in the last couple years, of anyone I've prescribed oral risperidone for. My nursing colleague discussed this lady's presentation with me and sought to start a low dose of oral risperidone. She persuaded me it was a reasonable plan to try then review, so we did. She also gave the home advice on how to handle this lady's interesting presentation.

Just 2 weeks on when she was reviewed, the care home staff say she's cured! All the malicious talk's stopped. She's still swearing like a trooper and nipping and scratching when staff try and help her bathe, but she's no longer biting. At meals and in the lounge she watches everything and grins to herself but can now bite her tongue and remain, if not prosocial, at least asocial rather than being antisocial.

A good result.


Jobbing Doctor said...

Interesting post, Shrink.

However, the Government and Media will castigate you for this and accuse you of using a "chemical cosh".

Elaine said...

I can see myself being like that before too long!

By the way is your Lake Cocytus picture sharpenedd up or is it just my new laptop?

The Shrink said...

JD, I know I'll be castigated, but then again if we did nothing and left her abusing other residents and assaulting staff we'd be equally chided, or more so!

She's not sedated, she's more in control, her hostility's reduced to acceptable levels, so my conscience is clear we're not simply sedating her (because, erm, she's not sedated!) and we're simply reducing abberant ideation so improving a greater, more lucid state of affairs where she's more in control more of the time.

Elaine, nope, if's your spangly new hardware - I've not changed the picture since I first placed it there!

Cat said...

Drugs do work - and it is easier to paint a very broad brush over the negative aspects ignoring the positives. It sounds like it has improved quality of life for the woman concerned, her family and the people around her without sedation. A result - as you say.

That's not my name! said...

Doesn't it come back to some kind of balance and professionals taking responsibility for what is prescribed alongside their understanding (such as it is) of the individual they are trying to help?

My concerns are always about what is being prescribed, the doses, efficacy and side effects.

If you and the staff in the home are working together...talking to each other and reviewing what is happening and all that is to do with providing the best care you can for a person then that is as good as it gets.

And if the meds are helping the person then there is no crime in that.

It is when meds are used to replace other things like compassion and understanding, that I have an issue.

I also have issues with pharma companies and their morals but that is another kettle of fish.

Milk and Two Sugars said...

A brilliant result, I think. It's a small expenditure and a pharmacologic means which is indicated where no amount of encouragement at behaviour modification is likely to help (given the frontal lobe damage she's hardly going to be persuaded against anything she has no interest in changing!).